In this week’s Architecture Focus, we’ll be concentrating on the various design aspects involved in healthcare architecture (hospitals, medical practices, specialistic clinics, etc.).

The main topic is on hospital design and an interesting insight regarding how the different types of structures with references to international standards have evolved in time and how they should be approached during the design phase.

A part from all the theory, you can also download the project drawings and DWG files of a pediatric clinic, built in Arkansas (USA), by Marlon Blackwell Architects and navigate through the project’s 3D model.

You can examine the requirements that are adopted for sanitary premises and review waiting areas together with furniture solutions, hospital rooms design criteria, pathways and the definition of spaces, including the description of the Harvey Pediatric clinic project in Arkansas (download the project drawings here).

Hospital facilities are a common topic for politicians, entrepreneurs, health workers and the whole community and are often under the spotlight for several reasons:

hospitals have had a central historical role and a major impact on the healthcare system and everyday life

financial resources destined to hospitals are generally huge both on total health expenditure and in absolute terms, covering several percentage points of GDP

hospitals maintain a very strong social and cultural role, they are part of most of families’ experience, attracting large interest, contribute to research and therefore to the evolution of knowledge in the medical sector

hospitals are fundamental elements in defining the urban and rural configuration and are often the largest enterprise of any local community

by definition, hospitals can represent a concentration of advanced technology and progress of this sector

The healthcare construction evolution

A first description reference of various modern hospital facilities is the multi-pavilion hospital structure, originating at the end of the 18th century. These building principles were applied, with some changes, until the middle of the twentieth century.

Various buildings (pavilions) are built with green areas and a large presence of general services.

Pavilions are equipped with everything necessary for the care of patients and their accomodation.

The designer must meet environmental comfort requirements, from ventilation and natural lighting to the buildings orientation.

The various pavilions are aggregated with a “linear”, “T”, “H”, circular or with honeycomb structured systems, simple or double and interspersed with large open spaces.

Hospital structures have become more complex over time:

specialized departments, such as operating theaters, laboratories or isolation departments, become autonomous from the structure.

specialized pavilions are designed according to the different types of illnesses and necessary cures, evolving into specialized hospitals.

wards are transformed into multi bedrooms up to single rooms for special needs.

The main downside of pavilion structured hospitals is the amount of space occupied. This can easily mean walking long distances from one area to another with higher expenses to cover and discomfort for patients and their families.

The first example of monoblock hospitals were built in the USA during the Twenties, having hospitalization, diagnosis, treatment and management-administration activities located in multi-storey buildings.

During the 40-50s, horizontally and vertically-aligned/block hospital facilities were preferred, placing hospitalization areas in the vertically developed part of the building, while services and patients care on the horizontal part.

Three types of design options can be distinguished when considering the latest hospital architecture development types:

megastructural – the hospital can assume different configurations because it is highly complex. These are types of health buildings that can be defined as multi-strategy buildings with flexibility. The building process thus extends to the management phase as well as the interventions planning.

adaptable buildings – complex works built through aggregative models that are based on the identification of ‘elementary functional units’ and on their plano-altimetric relationship. The most known examples are the British Harness, Nucleus and Oxford systems.

integrated into cities – the hospital integrates with the city and, while maintaining its nature, tends to incorporate some urban activities: residence, commerce, directionality. The healthcare architecture is thus enriched with semi-public spaces (square or shopping center) that can be used by patients, employees, visitors and the public.

The current trend is in the reorganization of internal spaces aiming at:

the enhancement and enlargement of technical and plant spaces.

the complete rooms renovation.

Healthcare architecture: some international references

Europe

On an international level, there are several European organizations and associations that aim at sharing standards relating to healthcare facilities, whether public, private or specialized clinics, in terms of methodologies and building approach.

The European Health Property Network operates in this sense. The main purpose of the members of the EuHPN is to interface and confront themselves to learn and share the standards of excellence in the healthcare construction industry The publication below is an example:

Generally, when designing healthcare environments, much of the attention is paid to areas that are recognized as more important, such as operating and intervention rooms (clinics, diagnostics), technical areas and areas of hospitalization. Spaces such as reception areas, waiting areas and corridors are often considered as secondary and impersonal spaces.

However, such areas represent the first environments encountered by users, and consequently have a major impact on the users’ opinion towards the whole structure.

In healthcare facilities, reception and waiting areas, in particular the atrium, connecting spaces, and waiting areas in general, have specific functions.

Atrium

The atrium is often the first contact between users and the hospital building, and has to sort people flows inside the building. The atrium hosts a series of basic elements, such as toilets, orientation signs for users, refreshment points, commercial spaces, but above all the reception / information area and acceptance.

Patients and visitors enter and move in the building through connective spaces, paths and landings that should have a good psychological impact.

Information boards, seats with small tables to favor breaks and conversation, benches, green elements and flower boxes, openings to the outside should all be elements to include in the hospital structure design.

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